RCN London Safe Staffing Report 2014

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2 RCN London Safe Staffing Report 2014 RCN Legal Disclaimer This publication contains information, advice and guidance to help members of the RCN. It is intended for use within the UK but readers are advised that practices may vary in each country and outside the UK. The information in this publication has been compiled from professional sources, but its accuracy is not guaranteed. Whilst every effort has been made to ensure the RCN provides accurate and expert information and guidance, it is impossible to predict all the circumstances in which it may be used. Accordingly, to the extent permitted by law, the RCN shall not be liable to any person or entity with respect to any loss or damage caused or alleged to be caused directly or indirectly by what is contained in or left out of this information and guidance. Published by the Royal College of Nursing, 20 Cavendish Square, London W1G 0RN 2014 Royal College of Nursing. All rights reserved. Other than as permitted by law no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise, without prior permission of the Publishers or a licence permitting restricted copying issued by the Copyright Licensing Agency, Saffron House, 6-10 Kirby Street, London EC1N 8TS. This publication may not be lent, resold, hired out or otherwise disposed of by ways of trade in any form of binding or cover other than that in which it is published, without the prior consent of the Publishers. For further information please contact: Ewan Russell, London Region Communications Officer, Royal College of Nursing,

3 Royal college of nursing Introduction During 2014 the number of budgeted NHS nursing posts has risen across the country. After several years of cutbacks as employers looked to balance the books, the Francis Report has driven a renewed focus on NHS staffing levels aimed at delivering good quality, safe patient care. London has benefited from its share of this boost to nursing numbers. London NHS trusts have increased nursing establishments in 2014 by four per cent, or around 2,500 posts. Every London trust but four increased their budgeted number of nurses this year. Around a thousand more nurses are now working in London s NHS compared to a year ago. However, within the headline rises of posts, we have seen continued cutbacks at senior levels. Our research shows four in five of the new jobs created have been at Band 5, while at Band 8a and above, posts have been cut by a further two per cent. And despite the new jobs available, London still suffers from a critical shortage of nurses. In 2014, vacancy rates for London nursing are running at fourteen per cent, up from eleven per cent last year. There are around 8,000 budgeted nursing posts in London sitting unfilled. A breakdown by employer is available on page 6 of this report. We are hearing of a particular strain on mental health services. This report contains on pages 4-5 the results of a survey of our London members who work in mental health. The results do not make for easy reading. The shortage of available, suitably qualified nurses is starting to have knock on effects for the ability of London s NHS to achieve the staffing levels which nursing colleagues desire and to keep providing safe care at the standard patients expect. Employers are increasingly reliant on temporary and agency staff to fill the gaps and many are also looking overseas to recruit in the shortterm. The result is we have witnessed increasing numbers of nurses from across the world come to work in London s NHS and, while we welcome the contribution these colleagues will make, it is not a sustainable long-term solution. Workforce plans need to address the previous deficits which have led to too few home grown nursing staff being trained. There are three steps to be taken which we believe would help. We are calling for a more strategic approach to long-term workforce planning to ease staffing challenges right across the region. We want the pay freeze ended as soon as possible. And we are looking to encourage better pastoral care for nursing staff who are living and working in the UK for the first time so that they are able to settle here in London. London remains an incredible place to live and to work. RCN London will continue to strive, alongside employers and NHS colleagues, to make the case for nursing staff from the UK or from abroad to come to our city to build a career. We will also keep doing all we can to encourage young people to consider what is still, despite all the challenges, the most fantastic and rewarding of professions. Bernell Bussue Regional Director, RCN London December

4 RCN London Safe Staffing Report 2014 London s recruitment crisis continues With a renewed focus on safe staffing levels after the Francis report most London trusts have increased their budgeted nursing establishments this year. The link between staffing numbers, skill mix and patient safety is now inescapable. In total, London budgeted nursing establishments have increased this year by four per cent, or around 2,500 posts. In practice the number of nurses working in London has increased by around However this means that only around forty per cent of the newly created posts this year have actually been filled. A major challenge for London s NHS is the critical shortage of registered nursing staff. Increasing demand from patients, combined with an ongoing pay freeze and the rising cost of living, means employers are finding it harder and harder to identify suitable candidates for vacant posts. In 2014, across London as a whole the NHS nursing vacancy rate is now at fourteen per cent, up from eleven per cent in In total around 8,000 London NHS nursing posts are now unfilled. The rate varies around the region, and seven individual employers reported vacancy rates of nineteen per cent or more, peaking at twenty three per cent. Only four London trusts have cut posts in 2014, but in reality nine now employ fewer nurses than a year ago. It seems employers are simply unable to find available staff. We have heard of trusts advertising jobs and not finding a single candidate who can attend an interview. More and more are looking overseas to recruit and a recent BBC survey found spending on temporary and agency staff of around 1m a month across some London trusts. Worryingly, within the headline figures we also found a continued hollowing out of senior posts. Four in five new posts are at Band 5. At Band 8a and above, posts have continued to be cut by two per cent. With such high turnover of staff and such pressure on services, the loss of leadership positions remains a worry for London nursing. Band Total London nursing vacancies July 14 Total London vacancy rate July % % % 8a and above 218 8% TOTAL % Band Change in establishment since April 2013 Estimated change in number of posts since April 2013 Change in total nurses employed since April 2013 Estimated change in total nurses employed since April % % % 437 0% % 199 3% 246 8a and above -2% -65 0% -9 TOTAL 4% % 956 Source: Freedom of Information request carried out by RCN London, August All posts whole time equivalent (WTE). 2

5 3 Royal college of nursing

6 RCN London Safe Staffing Report 2014 A strain on mental health services Throughout September 2014, we surveyed RCN London members working for NHS mental health providers about staffing levels at their work. The results show clear evidence of the growing strain on mental health nurses in London. New commissioning arrangements mean NHS providers are being undercut by the private sector. Services are increasingly fragmented. The squeeze from all sides on funding for mental health services is starting to cut into the quality of care which patients receive. The RCN s national Frontline First report Turning back the clock, published in November, showed that England has lost more than 3,000 mental health nurses and 1,500 mental health beds since Meanwhile cuts to specialist services have driven up hospital admissions over the same period. The Frontline First report calls for the right resources and funding, and commitment from all levels of Government, to ensure that this important arm of nursing is protected and can continue to care for and support people when they are at their most vulnerable. In our London survey, RCN members said they were increasingly having to work unpaid overtime, but many still said they were caring for unsafe numbers of patients on at least a weekly basis. Sixty nine per cent of members said their ward or unit had too few qualified nursing staff, while seventy per cent said that staffing levels were negatively impacting patient care. Sixty per cent said they were asked to care for more patients than is safe at least once a week. One Band 6 mental health nurse working in south London told us: I feel the job is becoming unsafe both for staff and patients. The option of actually offering any positive treatment is becoming less and less, and the job is mainly firefighting and crisis management. A lot of the time the only thing that gets jobs finished is the good will of staff. To be honest this is starting to become thin on the ground. And RCN members said they increasingly had to work longer hours to help plug the gaps. Forty seven per cent said they had to skip breaks on a daily basis, sixty two per cent said they worked unplanned overtime at least once a week, and twenty five per cent said they were working unplanned overtime every single day. One band 5 nurse said: I have never taken a break during a day shift for the past year, because there just aren t enough experienced staff on shift to manage the safety of the ward. Staffing shortages in London mean that mental health trusts are increasingly dependent on agency staff to get by. Fifty three per cent of those who took part in the survey said their shift relied on bank and agency staff every day. One Band 5 nurse in south London said: Every day on my unit you see new Band 5 bank staff and new Band 2 bank staff. And this is dangerously affecting patients care as patients are daily faced with new staff with a different approach. This measure is putting serious stress on staff themselves. As a permanent member of staff the entire workload for that shift is solely on your head. You can read the full results of the survey on the RCN London website at You can read more of the details of cuts to services nationally at 4

7 5 Royal college of nursing

8 RCN London Safe Staffing Report 2014 Freedom of Information results for 2014 nursing establishments and vacancies at London NHS trusts Total qualified nursing vacancies, July 2014 (WTE) Nursing vacancy rate July 14 LONDON TOTAL % Change to qualified nursing establishment since April 2013 (WTE) Change in total qualified nurses employed since April 2013 (WTE) Barking, Havering and Redbridge Hospitals % 4% 3% Barnet and Chase Farm Hospitals 116 8% Not given Not given Barnet, Enfield and Haringey Mental Health % 6% 7% Barts Health % -1% -6% Camden and Islington 96 21% 1% -6% Central London Community Healthcare 94 10% -15% -11% Central and North West London Mental Health 65 3% Not given Not given Chelsea and Westminster Hospital % 3% 1% Croydon Health Services % 14% 12% Ealing Hospital NHS Trust % 0% 1% East London NHS 102 9% 2% -1% Epsom and St Helier University Hospitals % 10% 1% Great Ormond Street Hospital for Children 41 3% 5% 7% NHS Foundation Guy's and St Thomas' % 5% 6% Hillingdon Hospital 87 11% 2% -2% Homerton University Hospital NHS % 4% 5% Hounslow and Richmond Community 79 23% 5% 2% Health Imperial College Healthcare % 2% 2% King's College Hospital % 57% 38% Kingston Hospital NHS Trust % 3% -2% Lewisham & Greenwich % 92% 85% Moorfields Eye Hospital 65 15% 8% 6% 6

9 Royal college of nursing North East London NHS North Middlesex University Hospital North West London Hospitals Oxleas NHS Foundation Trust Royal Brompton and Harefield NHS Royal Free Hampstead Royal Marsden NHS Royal National Orthopaedic Hospital South London and Maudsley NHS South West London & St George s Mental Health St George's Healthcare University College London Hospitals NHS West London Mental Health West Middlesex University Hospital Whittington Hospital Total qualified nursing vacancies, July 2014 (WTE) Nursing vacancy rate July 14 Change to qualified nursing establishment since April 2013 (WTE) Change in total qualified nurses employed since April 2013 (WTE) Not given Not given Not given Not given % 35% 32% % 12% 11% % 9% 4% % 7% 1% % 6% -1% % 0% 1% 67 15% 11% 3% % 0% -7% % -3% Not given % 8% 3% % 9% 7% % -9% -8% 69 12% 3% 1% % 4% 1% Notes: Data collected by a Freedom of Information request carried out by RCN London in August All posts given as whole time equivalent (WTE). Vacancy figures are rounded so may not match total. North East London is reorganising its nursing structure and said it was unable to give current figures. The establishment and vacancies at Kings and Lewisham are both significantly affected by taking on services from the former South London Healthcare. No 2013 South London Healthcare data was available. Barnet and Chase Farm and Royal Free have now merged. No 2013 figures were available for BCF. Royal Free figures are for Royal Free only. Central and North West London did not give comparable 2013 figures. Data for these trusts has therefore been omitted from the year on year comparison. 7

10 RCN London Safe Staffing Report 2014 What next? The Royal College of Nursing in London works closely with employers from across the region, as well as with NHS England (London), the Trust Development Agency and Health Education England, to help enable nursing staff to deliver good quality patient care. RCN London champions safe staffing levels and is committed to supporting members where they have concerns that poor nurse to patient ratios or skill mix are a threat to patient safety. For RCN members who are concerned about the safety of staffing levels at work, the first point of contact is RCN Direct who will be able to advise on the best support available to you. RCN Direct can be contacted on In London more generally, as patient demand and the cost of living both continue to go up, all employers are dealing with a growing shortage of nursing staff. There are three steps which RCN London believes must be taken to address this challenge. 1) We need a much more strategic approach to long term workforce planning. Too often decisions have been taken in a piecemeal fashion and training numbers have been set without consideration for the number of students who train in London then leave to work elsewhere. There has now been a welcome boost to training places but it will take several years for these recruits to come through the system. The bottleneck caused by recent cutbacks cannot be allowed to happen again in future years. 2) The Government must end the ongoing pay freeze which has been imposed on NHS staff for most of the past four years. Nationally, nurses pay has lagged eight per cent below inflation since This gap is even worse in London where the cost of living, particularly housing, has continued to spiral upwards. The Government needs to restore nursing as an attractive, affordable career option for Londoners to pursue. 3) In the short term we need better pastoral care for nurses coming to work here from overseas. New staff often face cultural challenges in working practices as well as the upheaval of living in a different country. Much more must be done, by employers and by the system as a whole, to enable new recruits to settle and build long-term careers here within London s health service. 8

11 The RCN represents nurses and nursing, promotes excellence in practice and shapes health policies December 2014 Published by the Royal College of Nursing, 20 Cavendish Square, London, W1G 0RN RCN Online RCN Direct Publication code:

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